Connections Program for High-Risk Infants and Families

Neonatal Intensive Care Unit (NICU) and Antepartum Unit at University of Colorado Hospital

This rotation offers psychology interns the opportunity to work as part of the inpatient consultation-liaison team at University of Colorado Hospital, engaging with both the Antepartum Unit (AP) and the Neonatal Intensive Care Unit (NICU). The hospital serves as a tertiary care facility, admitting patients from the local community, the state of Colorado, and the surrounding seven-state region. UCH houses multiple obstetric care settings, including an obstetric emergency department, labor and delivery unit, antepartum unit for women with maternal-fetal complications, and a mother-baby unit, as well as a Level III NICU. The NICU is the largest in metro Denver, routinely caring for critically ill babies born at 22 weeks and later.

Neonatal Intensive Care Unit (NICU): In the NICU, interns will work alongside clinicians to promote health and developmental outcomes for infants and engage families in the care process. The NICU team includes neonatologists, neonatal nurse practitioners, registered nurses, respiratory therapists, developmental therapists, lactation specialists, social workers, chaplains, and perinatal loss coordinators.

Antepartum Unit (AP): The Antepartum Unit provides care for pregnant individuals experiencing fetal and maternal medical complications that may necessitate early delivery. Interns will observe and participate in multidisciplinary team rounds, engaging with obstetricians, maternal-fetal medicine specialists, neonatologists, and nursing staff. They will assist in conducting psychological and behavioral health assessments, and regular interventions to support coping and adjustment to long term hospitalization.

Palliative Care/Loss: Psychologists both units offer palliative care and decision-making support to families regarding early delivery, withdrawal of care, and addressing concerns related to potential neonatal resuscitation. While interns are not assigned to families at high risk for loss, hospital courses can be unpredictable and it is possible that an intern will be exposed to loss in some capacity either through their own caseloads or they may be exposed to discussions and cases involving such situations on the unit. While this provides an opportunity to observe and learn about understand the emotional and psychological support provided in such circumstances, this can still be particularly emotionally challenging for interns without prior exposure to serious and life-threatening illness, palliative care, grief, and loss. Openness to learning about these themes, and willingness to explore emotional response to them during supervision is a requirement for this rotation.

Collaborate and liaise with a multidisciplinary team.
Develop health behavior assessment and intervention skills to promote infant health, development, and family coping/engagement in the NICU.
Conduct psychological and/or health behavior assessments and interventions to support expectant parents admitted for fetal and maternal complications during pregnancy for long admissions.
Build knowledge and skills in working with families of high-risk infants/high-risk pregnancies and provide psychoeducation and anticipatory guidance for needs that may present before, during and after NICU discharge.
Develop and coordinate treatment plans for infants and their families as they prepare for discharge.

Interns will learn CL skills for working in high-risk neonatal and obstetrics settings.
Obtain competence in health behavior assessment and intervention approaches for infants born with medical complexities.
Engage in consultation and liaison services with the medical team, including providing feedback about patient and family care approaches and trauma-informed care practices.

Health behavior assessments and interventions with infants and their families in the NICU.
Health behavior assessments and interventions and psychological assessments and interventions with antepartum patients.
Participation in multidisciplinary rounds and meetings.
Maternal mental health screening administration, interpretation, triage, and response.
Participation in quality improvement activities to improve family engagement in the NICU.
Preferred Qualifications: Prior experience in medical inpatient units, or other health psychology related settings, is preferred. Interns who do not have prior inpatient medical experience may be considered if they have demonstrated openness towards learning about themes related to the intersection of health and behavior, which may include serious illness, grief, and loss.

Maternal mental health screening and response.
Health Behavior Assessments and Interventions including caregiver-infant dyadic interventions, communication training, problem-solving skills training, brief cognitive-behavioral interventions to promote parental coping.
Participation in multidisciplinary team rounds.
Quality and process improvement.
Psychoeducation about infant social-emotional, behavioral, and cognitive development.
Multidisciplinary collaboration.
Consultation and Liaison services.

NICU Environment: The NICU provides Level III medical services to children born with neonatal complications and is the largest Level III NICU in Metro Denver. The unit cares for an average of 650 unduplicated patients per year. Approximately 25% of admitted infants are born at gestational ages less than 29 weeks and/or birth weight of less than 4 lbs, and about 20% are considered very low birthweight. The payer mix is around 40% Medicaid and 60% private insurance. Average length of stay is 14-17 days for the entire patient population. The Connections program delivers maternal mental health screening and response, health behavior interventions, and wellness promotion services to infants and families on the unit and during their transition home. Common themes families are experiencing include: perceived/real loss of control, traumatic pregnancy, birth, and/or postpartum experiences, adjusting to medical setting, adjusting to medical complications/language/etc, parental role, violation of expectations, and grief/loss. While interns are not assigned to work with families at a high risk for loss unless specifically agreed upon by intern and supervisor(s), hospital courses can be unpredictable, and it is possible that an intern will be exposed to loss in some capacity either through their own caseloads or hearing about loss while working on the unit.
Antepartum: The Connections Program automatically sees expectant parents admitted with maternal medical complications under 34 weeks. Additionally, the program sees all expectant parents with fetal complications who are admitted to the unit.
NICU: The Connections Program automatically sees infants born under 32 weeks gestation and older babies if specific concerns are identified that necessitate a consult to the service. Families from 32 weeks to 36 weeks gestation may be seen for single session assessments and interventions. All families are seen for screening at 1 months, 2 months, and 4 months.
Caseloads: On average, the team has a case load of approximately 25-30 infants/antepartum patients per week divided among the various clinicians on the service.

At least one hour of weekly supervision is provided to the intern for initial assessments, brief intervention, and consultation-liaison services. It is administered both before sessions with case conceptualization/treatment planning, directly after sessions, and formal supervision.
Service delivery is typically scaled: Initial learning involves direct observation of the supervisor (shadowing), followed by a preceptor model in which the clinician is present to observe a portion of the session and discuss case conceptualization and recommendations in real time. As clinicians demonstrate advancing skills, they may conduct assessments and interventions independently, with regular supervision to discuss case conceptualization and treatment planning before/after sessions.
We adopt developmental and reflective supervision approaches as well as behavioral supervision approaches (readings, structured activities, role play, case conceptualization). We work to align the training experiences with the trainee’s professional goals and training background/experiences.

Tools & Resources

CU Campuses

CU Anschutz

Department of Family Medicine

School of Medicine

Connections Program for High-Risk Infants and Families

Family Medicine

Connections Program for High-Risk Infants and Families

Goals of the Training Rotation

Objectives of the Training Rotation

Specific Training Activities

Supervisor Theoretical Approaches

Types of Clinical Approaches

Population of Clients

Supervision

Family Medicine